revenue vs. annual budget??

[Asysin2leads]

70% I think is a great figure. Ask them if they give the police and fire department a hard time for a 0% return.

[MightyMee]

Hello!

Just a fast note here: It has been my knowledge you should be collecting on the average for 400 runs $160,000.00. You should not have to spend out for expensive software for your billing. This saves you money. You should not have to hire and train people in house and cover the expense of doing this twice a year as help turns around. Sick days and personal days also cost you money.

If you are sending to a billing company, with this few runs a year, there should be no setup fee, no software to purchase or pay to access. You should be getting paid for every run! If it is a no insurance and patient responsibility the billing company should be working with the patient to insure they pay (no hard core collections required), after insurance pays the patient should have to pay what the insurance advises is patient responsibility. You cannot just FORGIVE co-pays and deductibles, that is fraud. Their by the ever popular subscriptions are walking a fine line if they are forgiving co-pays and deductibles for the subscription amount. If insurance is NOT paying the correct amount the billing company should be catching it and asking for proper reimbursement. Denials should be appealed in all cases! MVA insurance should be billed and if in the hands of the atty's it should be followed up. ALL accounts should be sent to insurance within a 3 day time period of receiving the information. If the billing company does not have all the required information they should be contacting the patient and or your company or even the hospital to get the information. They should be working to get you the money not just saying "oh well we don't have the information so we aren't billing it" It can and should be obtained. The billing company should be doing PROPER coding!

All this said and followed you should be getting the highest possible reimbursement and something on each and every run! The average payment per run is $400.00 some higher and medicaid lower! But the rule of thumb is $400 per EACH run.

Hope this helps!

Marilyn

Specialist EMS Billing

[RuralEMT-I]

We are not a tax based agency. We do inhouse billing. Our collection rate is 67% of the total amount billed. Our average bill is $945.00. We have between 250-300 runs annually, 60% ALS, 40% BLS. We work with patients without insurance; as long as they pay something monthly (even $10.00) we wont send them to collections.

We make a profit, all of it is put back into the business in the form of improvements or savings for improvements and special projects. We arent "rich" by any means, we just have learned to live within our budget. Planning is crucial. We plan for the worse case scenario, when looking at both expected income and expenses. Its not easy but it can be done.

[Just Plain Ruff]

the original poster posted this one telling sentence::::

The revenue, unfortunately, goes to the general fund not ems

No wonder why you aren't profitable. Any chance of profits are going into the general fund that is free pickings for all your other agencies the general fund helps support.

Another fine example of how well government runs things.

[Amhet1]

There is a formula in Fitch, Prehospital Care Administration, 2nd ed, where you can graph subsidy to rate. In the calculation, you can show what the service would cost at $0 subsidy and how much subsidy you would need if your rate was $xxx.xx.

If your municipal service is able to generate 70% of its operating revenue, then the govt entities must provide 30% subsidy for current operations. If the municipalities want to see a "profit", they will need to increase taxes, increase rates, or both. But as a govt agency, there should be no "profit".

Ruff is right on the money about the actual revenue generated going to the general fund. In that scenario, your service is actually 100% supported by subsidy since your revenue generated doesnt actually go to you for operating the service.

Scrolling back, I saw Woody's concerns about needing to hire 2 people to do the billing on 400 calls a year...... 1.09 runs per day..... either Woody is from NJ or some other liberal state or he meant 400 calls per day or month..... Whether its 1 or 10 calls per day, they should be able to handle it in-house.

My other concern is comments that you should be getting 100% reimbursement on billable responses. What scares me it the over-simplification of the theory. There are multiple sources of revenue on some transports, but it only takes one indigent to break the 100% reimbursement rate. There may be a magic formula that will calculate the payor mix, reimbursement rate from Medicare, private insurors, Medicaid, etc, but the fact is that 70% recovery is a reasonable rate for self-billing services. To say that you should get an average of $400 a run 100% of the time fails to take into account ALL of the variables. Some services may only have a 2 mile transport whereas others may have 30 miles. There are services in BFE Colorado that may have to transfer patients 120 miles from a CAH to a Medical Center. As you may know from the Medicare reimbursement tables, part of that transport is billed at $9 a mile, some at $5. In the case of an MVC, some of that should be paid by auto insurance, over 65 and Medicare pays some of it, and if they also have private insurance. Was this a BLS-E, ALS-1.... I think you get the point. You also have to take into account the co-insurance, co-payments, and what to do with the outstanding balance after everyone has paid what they are going to. A service can charge whatever they want, be it $100 or $10,000... they wil be reimbursed whatever insurance says they will be reimbursed.

One other point Id like to make is that each service is unique. I question 400 calls a year and a budget of $180,000, but I dont know the whole picture. The demographics of a community and the service supporting it has alot to do with costs and reimbursements and subsidy. If a community has set a standard of 8:59 or they want volunteer/part-time paid then those are the standards for the service and community.

This becomes an issue not unlike a post about MBA's running EMS. I made the comment that there are specialties outside of EMS that we need to tap into to improve EMS. If I see numbers that dont pass the "smell test", I want someone with the knowledge to know why.